{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:36:27Z","timestamp":1791909387467,"version":"4.3.4"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n OBJECT<\/jats:title>\n Ependymomas represent the most common intramedullary tumor in adults. Despite their usually well-defined dissection plane, surgical morbidity has been documented to be considerably higher compared with other intramedullary entities. This study presents an analysis of risk factors for surgical morbidity and data on long-term results for intramedullary ependymomas.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Among 1447 patients with tumors of the spinal canal treated between 1980 and 2014, 309 patients presented with intramedullary tumors. One hundred patients with intramedullary ependymomas underwent 102 operations. Mean age was 44 \u00b1 15 years (range 8\u201374 years). Patients were followed by outpatient visits and questionnaires, with a mean follow-up of 77 \u00b1 91 months. Short-term results were determined for individual symptoms and the McCormick Scale, whereas tumor recurrence rates were calculated with Kaplan-Meier statistics.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Compared with cervical ependymomas, those of the thoracic spine were associated with more severe motor deficits and gait problems at presentation. A total of 86.3% of patients with intramedullary ependymomas underwent gross-total resection (GTR). A low preoperative McCormick grade and first surgery were the strongest predictors for a GTR. Postoperatively, 67.6% of patients demonstrated a worse neurological state at discharge from the hospital. This deterioration was transient for 40.1% of the patients and permanent for 27.5%. In the long term, the McCormick grade remained unchanged from the preoperative grade in 74.5% of patients, while it was improved in 5.9% of patients and increased after surgery in 19.6% of patients. According to a multivariate analysis, the risk of permanent morbidity increased with a thoracic level of the ependymoma, advanced age, a long clinical history, presence of a tumor hemorrhage, and surgery on a recurrent tumor. In the long term, tumor recurrence rates correlated significantly with the amount of resection (4.2% and 18.5% in 20 years after GTR and partial resections, respectively). Postoperative neuropathic pain syndromes affected 37.0% of patients, whereas 4% demonstrated a postoperative myelopathy related to cord tethering at the level of surgery.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Intramedullary ependymomas are tumors best treated surgically. A complete resection indicates cure for the overwhelming majority of these patients. Surgery should be performed early by neurosurgeons who deal with these lesions on a regular basis to achieve high GTR rates. Permanent surgical morbidity varies most according to tumor location and patient age.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.5.focus15161","type":"journal-article","created":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T03:39:09Z","timestamp":1438400349000},"page":"E6","source":"Crossref","is-referenced-by-count":108,"title":["Spinal ependymomas. Part 1: Intramedullary ependymomas"],"prefix":"10.3171","volume":"39","author":[{"given":"J\u00f6rg","family":"Klekamp","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Christliches Krankenhaus, Quakenbr\u00fcck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15161","series-title":"Neurochirurgie","first-page":"344","article-title":"Intramedullary tumors. Results of a national investigation in private neurosurgery","volume":"56","author":"Adam","year":"2010"},{"key":"b2-focus15161","series-title":"Neurosurgery","first-page":"1279","article-title":"Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit","volume":"62","author":"Aghakhani","year":"2008"},{"key":"b3-focus15161","series-title":"Neurosurgery","first-page":"302","article-title":"Surgery for spinal cord ependymomas: outcome and prognostic factors","volume":"68","author":"Bostr\u00f6m","year":"2011"},{"key":"b4-focus15161","series-title":"Eur Spine J","first-page":"665","article-title":"Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome","volume":"19","author":"Ebner","year":"2010"},{"key":"b5-focus15161","series-title":"Acta Neurochir (Wien)","first-page":"611","article-title":"Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome","volume":"152","author":"Eroes","year":"2010"},{"key":"b6-focus15161","series-title":"Intramedullary Spinal Cord Tumors","author":"Fischer","year":"1996"},{"key":"b7-focus15161","series-title":"J Neurosurg Spine","first-page":"591","article-title":"Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases","volume":"11","author":"Garc\u00e9s-Ambrossi","year":"2009"},{"issue":"2 Suppl","key":"b8-focus15161","series-title":"J Neurosurg","first-page":"181","article-title":"Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma","volume":"99","author":"Goto","year":"2003"},{"key":"b9-focus15161","series-title":"J Am Stat Assoc","first-page":"457","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958"},{"key":"b10-focus15161","series-title":"Neurosurgery","first-page":"188","article-title":"Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients","volume":"68","author":"Karikari","year":"2011"},{"key":"b11-focus15161","series-title":"J Neurosurg Spine","first-page":"12","article-title":"Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results","volume":"19","author":"Klekamp","year":"2013"},{"key":"b12-focus15161","series-title":"Neurosurgery","first-page":"376","article-title":"Treatment of syringomyelia related to nontraumatic arachnoid pathologies of the spinal canal","volume":"72","author":"Klekamp","year":"2013"},{"key":"b13-focus15161","series-title":"Acta Neurochir (Wien)","first-page":"221","article-title":"Introduction of a score system for the clinical evaluation of patients with spinal processes","volume":"123","author":"Klekamp","year":"1993"},{"key":"b14-focus15161","series-title":"Surgery of Spinal Tumors","author":"Klekamp","year":"2007"},{"key":"b15-focus15161","series-title":"Syringomyelia - Diagnosis and Treatment","author":"Klekamp","year":"2001"},{"issue":"1 Suppl Operative","key":"b16-focus15161","series-title":"Neurosurgery","first-page":"57","article-title":"Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas","volume":"68","author":"Kucia","year":"2011"},{"key":"b17-focus15161","series-title":"Neuro Oncol","first-page":"921","article-title":"Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group","volume":"15","author":"Lee","year":"2013"},{"key":"b18-focus15161","series-title":"Korean J Spine","first-page":"121","article-title":"Neurological outcome after surgical treatment of intramedullary spinal cord tumors","volume":"11","author":"Lee","year":"2014"},{"key":"b19-focus15161","series-title":"J Neurosurg Spine","first-page":"249","article-title":"Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients: clinical article","volume":"21","author":"Li","year":"2014"},{"key":"b20-focus15161","series-title":"Clin Neurosurg","first-page":"512","article-title":"Intramedullary spinal cord tumors","volume":"25","author":"Malis","year":"1978"},{"key":"b21-focus15161","series-title":"Spinal Cord","first-page":"540","article-title":"Contemporary management of adult intramedullary spinal tumors-pathology and neurological outcomes related to surgical resection","volume":"46","author":"Manzano","year":"2008"},{"key":"b22-focus15161","series-title":"J Neurosurg Spine","first-page":"404","article-title":"Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection","volume":"10","author":"Matsuyama","year":"2009"},{"key":"b23-focus15161","series-title":"J Neurosurg","first-page":"523","article-title":"Intramedullary ependymoma of the spinal cord","volume":"72","author":"McCormick","year":"1990"},{"key":"b24-focus15161","series-title":"J Neurosurg Pediatr","first-page":"63","article-title":"Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits","volume":"1","author":"McGirt","year":"2008"},{"key":"b25-focus15161","series-title":"Neuroradiology","first-page":"828","article-title":"MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement","volume":"42","author":"Miyazawa","year":"2000"},{"key":"b26-focus15161","series-title":"J Orthop Sci","first-page":"352","article-title":"Central neuropathic pain after surgical resection in patients with spinal intramedullary tumor","volume":"17","author":"Nakamura","year":"2012"},{"key":"b27-focus15161","series-title":"Spinal Cord","first-page":"34","article-title":"Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients","volume":"43","author":"Sandalcioglu","year":"2005"},{"key":"b28-focus15161","series-title":"Clin Neurosurg","first-page":"529","article-title":"Surgery of intramedullary spinal cord tumors","volume":"26","author":"Stein","year":"1979"},{"key":"b29-focus15161","series-title":"Clin Neurosurg","first-page":"361","article-title":"Intramedullary neoplasms and vascular malformations","volume":"39","author":"Stein","year":"1992"},{"key":"b30-focus15161","series-title":"J Clin Neurosci","first-page":"666","article-title":"Microsurgical treatment and functional outcomes of multi-segment intramedullary spinal cord tumors","volume":"16","author":"Sun","year":"2009"},{"key":"b31-focus15161","series-title":"Neurosurg Rev","first-page":"85","article-title":"Comparative analysis on the diagnosis and treatments of multisegment intramedullary spinal cord tumors between the different age groups","volume":"35","author":"Wang","year":"2012"},{"key":"b32-focus15161","series-title":"Neurosurgery","first-page":"99","article-title":"Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors","volume":"61","author":"Woodworth","year":"2007"},{"key":"b33-focus15161","series-title":"Spine (Phila Pa 1976)","first-page":"2705","article-title":"Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors","volume":"34","author":"Yang","year":"2009"},{"key":"b1-focus15161","series-title":"Neurochirurgie","first-page":"344","article-title":"Intramedullary tumors. Results of a national investigation in private neurosurgery","volume":"56","author":"Adam","year":"2010"},{"key":"b2-focus15161","series-title":"Neurosurgery","first-page":"1279","article-title":"Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit","volume":"62","author":"Aghakhani","year":"2008"},{"key":"b3-focus15161","series-title":"Neurosurgery","first-page":"302","article-title":"Surgery for spinal cord ependymomas: outcome and prognostic factors","volume":"68","author":"Bostr\u00f6m","year":"2011"},{"key":"b4-focus15161","series-title":"Eur Spine J","first-page":"665","article-title":"Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome","volume":"19","author":"Ebner","year":"2010"},{"key":"b5-focus15161","series-title":"Acta Neurochir (Wien)","first-page":"611","article-title":"Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome","volume":"152","author":"Eroes","year":"2010"},{"key":"b6-focus15161","series-title":"Intramedullary Spinal Cord Tumors","author":"Fischer","year":"1996"},{"key":"b7-focus15161","series-title":"J Neurosurg Spine","first-page":"591","article-title":"Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases","volume":"11","author":"Garc\u00e9s-Ambrossi","year":"2009"},{"issue":"2 Suppl","key":"b8-focus15161","series-title":"J Neurosurg","first-page":"181","article-title":"Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma","volume":"99","author":"Goto","year":"2003"},{"key":"b9-focus15161","series-title":"J Am Stat Assoc","first-page":"457","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958"},{"key":"b10-focus15161","series-title":"Neurosurgery","first-page":"188","article-title":"Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients","volume":"68","author":"Karikari","year":"2011"},{"key":"b11-focus15161","series-title":"J Neurosurg Spine","first-page":"12","article-title":"Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results","volume":"19","author":"Klekamp","year":"2013"},{"key":"b12-focus15161","series-title":"Neurosurgery","first-page":"376","article-title":"Treatment of syringomyelia related to nontraumatic arachnoid pathologies of the spinal canal","volume":"72","author":"Klekamp","year":"2013"},{"key":"b13-focus15161","series-title":"Acta Neurochir (Wien)","first-page":"221","article-title":"Introduction of a score system for the clinical evaluation of patients with spinal processes","volume":"123","author":"Klekamp","year":"1993"},{"key":"b14-focus15161","series-title":"Surgery of Spinal Tumors","author":"Klekamp","year":"2007"},{"key":"b15-focus15161","series-title":"Syringomyelia - Diagnosis and Treatment","author":"Klekamp","year":"2001"},{"issue":"1 Suppl Operative","key":"b16-focus15161","series-title":"Neurosurgery","first-page":"57","article-title":"Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas","volume":"68","author":"Kucia","year":"2011"},{"key":"b17-focus15161","series-title":"Neuro Oncol","first-page":"921","article-title":"Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group","volume":"15","author":"Lee","year":"2013"},{"key":"b18-focus15161","series-title":"Korean J Spine","first-page":"121","article-title":"Neurological outcome after surgical treatment of intramedullary spinal cord tumors","volume":"11","author":"Lee","year":"2014"},{"key":"b19-focus15161","series-title":"J Neurosurg Spine","first-page":"249","article-title":"Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients: clinical article","volume":"21","author":"Li","year":"2014"},{"key":"b20-focus15161","series-title":"Clin Neurosurg","first-page":"512","article-title":"Intramedullary spinal cord tumors","volume":"25","author":"Malis","year":"1978"},{"key":"b21-focus15161","series-title":"Spinal Cord","first-page":"540","article-title":"Contemporary management of adult intramedullary spinal tumors-pathology and neurological outcomes related to surgical resection","volume":"46","author":"Manzano","year":"2008"},{"key":"b22-focus15161","series-title":"J Neurosurg Spine","first-page":"404","article-title":"Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection","volume":"10","author":"Matsuyama","year":"2009"},{"key":"b23-focus15161","series-title":"J Neurosurg","first-page":"523","article-title":"Intramedullary ependymoma of the spinal cord","volume":"72","author":"McCormick","year":"1990"},{"key":"b24-focus15161","series-title":"J Neurosurg Pediatr","first-page":"63","article-title":"Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits","volume":"1","author":"McGirt","year":"2008"},{"key":"b25-focus15161","series-title":"Neuroradiology","first-page":"828","article-title":"MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement","volume":"42","author":"Miyazawa","year":"2000"},{"key":"b26-focus15161","series-title":"J Orthop Sci","first-page":"352","article-title":"Central neuropathic pain after surgical resection in patients with spinal intramedullary tumor","volume":"17","author":"Nakamura","year":"2012"},{"key":"b27-focus15161","series-title":"Spinal Cord","first-page":"34","article-title":"Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients","volume":"43","author":"Sandalcioglu","year":"2005"},{"key":"b28-focus15161","series-title":"Clin Neurosurg","first-page":"529","article-title":"Surgery of intramedullary spinal cord tumors","volume":"26","author":"Stein","year":"1979"},{"key":"b29-focus15161","series-title":"Clin Neurosurg","first-page":"361","article-title":"Intramedullary neoplasms and vascular malformations","volume":"39","author":"Stein","year":"1992"},{"key":"b30-focus15161","series-title":"J Clin Neurosci","first-page":"666","article-title":"Microsurgical treatment and functional outcomes of multi-segment intramedullary spinal cord tumors","volume":"16","author":"Sun","year":"2009"},{"key":"b31-focus15161","series-title":"Neurosurg Rev","first-page":"85","article-title":"Comparative analysis on the diagnosis and treatments of multisegment intramedullary spinal cord tumors between the different age groups","volume":"35","author":"Wang","year":"2012"},{"key":"b32-focus15161","series-title":"Neurosurgery","first-page":"99","article-title":"Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors","volume":"61","author":"Woodworth","year":"2007"},{"key":"b33-focus15161","series-title":"Spine (Phila Pa 1976)","first-page":"2705","article-title":"Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors","volume":"34","author":"Yang","year":"2009"}],"container-title":["Neurosurgical 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